SHJ25-011 UNITED HEALTHCARE & KCJ Carceral 2025 Medicaid Contract - PARTIALLY EXECUTED

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447.45(d)(2), 42 CFR 447.45(d)(3), 42 CFR 447.45(d)(5) and 42 CFR 447.45(d)(6), as maybe amended from time to time. To be compliant with both payment standards, Carrier shall pay 95 percent of Clean Claims within thirty (30) calendar days of receipt, 95 percent of all Claims within sixty (60) calendar days of receipt and 99 percent of Clean Claims within ninety (90) calendar days of receipt; provided, however, that Carrier and Provider may agree to a different payment requirement in writing on an individual Claim. If a third party liability exists, payment of Claims shall be determined in accordance with federal and/or State third party liability law and the terms of the State Contract. Unless Carrier otherwise requests assistance from Provider, Carrier will be responsible for third party collections in accordance with the terms of the State Contract. 5.2 No Incentives to Limit Medically Necessary Services. Carrier shall not structure compensation provided to individuals or entities that conduct utilization management and concurrent review activities so as to provide incentives for the individual or entity to deny, limit, or discontinue Medically Necessary services to any Covered Person. 5.3 Provider Discrimination Prohibition. In accordance with 42 CFR 438.12 and 438.21.4(c), Carrier shall not discriminate with respect to the participation, reimbursement or indemnification of a provider who is acting within the scope of such provider's license or certification under applicable State law, solely on the basis of such license or certification. Further, Carrier shall not discriminate with respect to the participation, reimbursement or indemnification of any provider who serves high -risk Covered Persons or specializes in conditions requiring costly treatments. This provision shall not be construed as prohibiting Carrier from limiting a provider's participation to the extent necessary to meet the needs of Covered Persons. This provision also is not intended and shall not interfere with measures established by Carrier that are designed to maintain quality of care practice standards and control costs. 5.4 Communications with Covered Persons. Carrier shall not prohibit or otherwise restrict Provider, when acting within the lawful scope of practice, from advising or advocating on behalf of a Covered Person for the following: i) The Covered Person's health status, medical care, or treatment options, including any alternative treatment that may be self-administered; ii) Any information the Covered Person needs in order to decide among all relevant treatment options; iii) The risks, benefits, and consequences of treatment or non -treatment; or iv) The Covered Person's right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions. Carrier also shall not prohibit a Provider from advocating on behalf of a Covered Person in any grievance system, utilization review process, or individual authorization process to obtain necessary health care services. 5.5 Grievance & Appeals. Carrier will supply Provider with information regarding Carrier's grievance and appeals system, including: (a) the toll -free numbers to file oral grievances and appeals; (b) the availability of assistance in filing a grievance or appeal; (c) a Covered Person's rights to request continuation of benefits during an appeal or hearing and, if Carrier's action is upheld, the Covered Person's responsibility to pay for the cost of the benefits received for the first 60 calendar days after the appeal or hearing request was received; (d) a Covered Person's right to file grievances and appeals and the requirements and timeframes for filing, to include the Uh'C/STATE PROGRAMS REGAPX WA.02.25 41